ATI RN
Introduction to Community Health Nursing Questions
Question 1 of 5
During the physical examination, the nurse uses various techniques to assess structures, organs, and body systems. Which technique allows the nurse to feel for vibration and locate body structures?
Correct Answer: C
Rationale: The correct answer is C: Palpation. Palpation involves using hands to feel for vibration and locate body structures. This technique allows the nurse to assess for tenderness, texture, temperature, and size of organs or structures. Auscultation (A) involves listening for sounds using a stethoscope, not feeling. Inspection (B) involves visual examination, not tactile assessment. Percussion (D) involves tapping the body to listen for sounds, not feeling for vibration or locating structures. Palpation is the most appropriate technique for this purpose.
Question 2 of 5
While the client has a pulse oximeter on his fingertip, the nurse notices that sunlight is shining on the area of the sensor. The nurse’s action should be:
Correct Answer: C
Rationale: The correct answer is C: Cover the fingertip sensor with a towel or bedsheet. Sunlight shining on the sensor can interfere with accurate readings. By covering the sensor, the nurse eliminates the external light source and ensures correct measurements. Choice A is incorrect because sunlight can affect the accuracy of the pulse oximeter readings. Choice B is incorrect because changing the sensor location every 4 hours does not address the immediate issue of sunlight interference. Choice D is incorrect as setting the alarm does not solve the problem of sunlight affecting the sensor's accuracy.
Question 3 of 5
In performing enemas, the indicated height for adults should be:
Correct Answer: D
Rationale: The correct answer is D: 12-18 inches above the rectum. This height range ensures proper flow of the enema solution through gravity. If the enema bag is positioned too low (A), gravity may not assist in the flow. Placing it 10-16 inches above the bed (B) is not specific to the rectum. Option C (12-18 inches above the bed) does not guarantee proper flow into the rectum. Therefore, option D is the most appropriate height range for successful administration of the enema solution.
Question 4 of 5
If a client has been suctioned, how long should the nurse wait before drawing an arterial blood gas?
Correct Answer: D
Rationale: The correct answer is D (20 minutes) because after suctioning, it takes time for the respiratory system to stabilize and for arterial blood gas values to return to baseline. Waiting 20 minutes allows for accurate assessment of respiratory status. Choice A (5 minutes) is too soon and may lead to skewed results due to immediate changes post-suctioning. Choice B (10 minutes) is still too early for accurate results. Choice C (15 minutes) is closer but may not provide sufficient time for full recovery post-suctioning. Therefore, waiting for 20 minutes ensures more reliable arterial blood gas values.
Question 5 of 5
To obtain a specimen for a stool culture, the nurse should:
Correct Answer: C
Rationale: The correct answer is C because using tongue blades to transfer the stool into the container minimizes the risk of contamination. Placing a large stool directly into the container (A) may introduce contaminants. Using a dry container (B) may not preserve the specimen adequately. Dipping a rectal swab into the stool and placing it into a sterile test tube (D) may not provide enough sample for culture.